Unscheduled acute care in London: mapping models of care and understanding the impact of quality standards

There are substantial differences in the ways that hospitals arrange and manage their acute care services. We are exploring how these varying models support processes such as NHS London’s Quality Standards for Acute and Emergency Care, and how they impact on quality of care for acutely unwell patients.

NHS London developed and introduced Quality Standards for Acute and Emergency Care between 2011 and 2014, as part of its commitment to improve care for patients with unscheduled medical need.

The introduction of the standards had two distinct phases – an initial professionally-led phase and commissioning-led implementation.

This Nuffield Trust study will explore this approach to driving change, and the consequences and outcomes for acute medicine.

We know anecdotally that there are substantial differences in the ways that hospitals arrange their acute care services. This mosaic of services for the acutely unwell medical patient has never been mapped.

We are looking to understand how the varying models of care support high-quality processes, such as those contained in the NHS London standards. In particular we will be exploring:

• the characteristics (service model and staffing) of acute care services across London hospitals

• the processes involved in introducing, and the impact of, the NHS London standards

• the barriers and enablers to implementing the standards

• the degrees to which the professionally- and commissioning-led approaches have driven improvements in patient care

• the relationship between models of acute medical care and the ability to support processes associated with high-quality care.

Scoping work will be undertaken in all London hospitals, with some sites selected for more in-depth work.

Our work will include:

• mapping of acute services and key patient pathways

• surveys of senior clinicians and managers

• interviews with NHS London and other staff involved in the development, introduction and audit of the standards

• interviews and focus groups with hospital staff involved in the introduction of the standards

• workshops to consider approaches and findings, and how this may translate into better practice.

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About us

The Nuffield Trust is an independent health charity. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.